Laserfiche WebLink
0 <br />is <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT �( CALL 209 953-7697 FOR INSPECTIONS e IqP1IRES "I YEAR FROM UATE ISSUE. <br />JOB ADDRESSv// <br />Vj1 - A � C <br />�ITY/ZIP O c <br />CROSS STREET w APN r-)! / O �O 0 + _ _ PARCEL SIZE <br />OWNER NAME V_,�� V PHONE <br />OWNER ADDRESS I � 1 �j 1�( Iy(u rr 4 y CITY/STATE/ZIP L t I-, S, in,` //► kq 57Z -S(, <br />CONTRACTOR PHONE -L9 -7 "(0 17 U QUI <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE ❑DC -42 11EIC-36 OTHER NUMBER EXPIRATION DATE <br />7 <br />14 <br />L4 <br />ILEACHING CHAMBERS <br />WATER TABLE DEPTH: <br />' O ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />❑ PERC TEST # <br />BUILDING PERMIT # LAND USE APPLICATION # <br />ft <br />TYPE OF WORK: <br />LI NEW INSTALLATION REPAIR/ADDITION <br />❑ ENGINEER DESIGNED /ALTERNATIVE C <br />❑ <br />REPLACEMENT _ OUT -OF -SERVICE SEPTIC SYSTEM <br />- DESTRUCTION k <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 <br />NUMBER OF EMPLOYEES: <br />xSEPTIC TANK <br />TYPE/MFG O r1C-rc- ~ CAPACITY 12-00 <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG CAPACITY <br />gal # OF COMPARTMENTS <br />ft <br />{ <br />DISTANCE TO NEAREST: WELL 1 0 d ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND <br />OIL SEPARATOR (ENCLOSED SYSTEM) <br />14 <br />LEACH LINES <br />ILEACHING CHAMBERS <br />Check#/ <br />Cash <br /># OF LINES <br />Z LENGTH OF LINES O Zi ft <br />DISTANCE TO NEAREST WELL '/eo <br />ft <br />FOUNDATION <br />ft PROPERTY LINE �� <br />It <br />❑ <br />FILTER BED <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />N 10UNDED <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />ft <br />)14 <br />SEEPAGE PITS <br />NUMBER Z WIDTH <br />4 -q <br />ft DEPTH Z -S <br />ft <br />DISTANCE TO NEAREST WELL IS C> <br />ft <br />FOUNDATION <br />It PROPERTY LINE D <br />ft <br />I HEREBY CERTIFY TFAT <br />I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />M/AIIMIAIII <br />R dill/AAIrF AInnrx PF7nmPj= I FnR INCPFrTInA/C <br />- PI Fd SF rAt 1 /9/IQI 054_7907 <br />SIGNED <br />Application Accepted By <br />Final Inspection By <br />_ �ra;2 <br />Character of Soil to Depth of 3 <br />COMMENTS PP 11 M <br />DATE 10q (1 d( t I X j <br />TMENT USE ONLY <br />Date Area q lO <br />Employee ID# rG� <br />Date 20 �I-C'44 ❑ SPECIAL PERMIT - Approved by <br />Pit/Sump Soil Character: <br />cw l Z/I �Dt t0 ;i1 S � � f � �✓i �oC4' <br />-i j i <br />v /. a9L � -1 Oar rm <br />PE <br />Code <br />SC <br />INFO <br />Received <br />Check#/ <br />Cash <br />Amount Date Permit/ Invoice # Permit ID# <br />Remitted Service Re uest # <br />Z�LAJ <br />IV <br />G <br />42-01 D <br />4/14/18 <br />t'T 4 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />Ei <br />